Onychomycosis in inflammatory bowel diseases.

BACKGROUND: As far as we have sought for in Medline and PubMed, not one study until now has evaluated the prevalence of onychomycosis in patients with inflammatory bowel disease (IBD). As there are great evidence of immunological disturbances linked to IBD, a possible relationship of this nail infection in association with those diseases and the possible risk factors might be relevant in IBD patients. METHODS: A case-control prospective study using combined direct smear and cultures for fungus was performed. Sociodemographics, clinical and laboratorial data were recorded at baseline and samples of suspected nails were collected from 141 IBD (61 men and 80 women) and from a group of 100 non-IBD subjects (41 men and 59 women). Direct smear and cultures were performed on each suspected case to exclude other onychodystrophies. RESULTS: The incidence of onychomycosis in IBD patients was highly significant in comparison to non-IBD patients (14.9% vs. 6%, respectively, P < 0.05). The risk factors predisposing IBD patients to onychomycosis were older age (P = 0.02) and leucopoenia in those using azathioprine therapy (P = 0.04) beyond a trend to lymphopenia (P = 0.06). The dermatophytes predominated (76.2%) over yeasts (19%) and moulds (4.8%). CONCLUSION: The prevalence of onychomycosis in IBD patients was expressively high (14.9%) in comparison with non-IBD patients. Considering the sociodemographic factors, any one but two were related to fungal onychomycosis incidence. Therefore, as far as we are concerned, IBD must be included in the high-risk underlying conditions for onychomycosis occurrence.

Colonic ulcers in propylthiouracil induced vasculitis with secondary antiphospholipid syndrome.

A 48 year old white woman was admitted to the hospital because of several bouts of migratory polyarthritis, weight loss, fever, and abdominal pain over a period of 15 months. She had been taking propylthiouracil 100 mg daily for three years for hyperthyroidism treatment. A test for antineutrophil cytoplasmic autoantibodies (ANCA) was positive with a perinuclear pattern of staining. Antiphospholipid antibodies were also detected. Colonoscopy showed several ulcers on intestinal mucosa and the biopsy specimen showed intense microscopic vasculitis. The patient is well after methylprednisolone pulse therapy and eight months of oral azathioprine. A surveillance colonoscopy showed complete healing of intestinal ulcers. No recurrence of symptoms has occurred and autoantibodies are negative, 10 months after treatment finished. The sequence of events suggests a propylthiouracil induced vasculitis p-ANCA positive and an antiphospholipid syndrome. This is the first report of colonic ulcers diagnosed and successfully treated in such circumstances.

Pancreatite hereditária / Hereditary pancreatitis

Pancreatite hereditaria (PH) é uma causa rara de pancreatite crônica cuja manifestaçäo clínica mais comum é a dor abdominal recorrente que se inicia na infância ou na adolescência. OBJETIVO. Relatar um caso de PH com apresentaçäo atipica e revisäo da literatura. MÉTODOS. Estudou-se um paciente näo etilista, sem história de dor abdominal, que apresentava quadro de esteatorréia e desnutriçäo. A investigaçäo diagnóstica revelou a presença de pancreatite crônica avançada. Dois outros casos semelhantes foram detectados na família. Aspectos clínicos e epidemiológicos desta entidade foram revisados. CONCLUSäO. PH, embora incomum, deve fazer parte do diagnóstico diferencial das pancreatites crônicas, efetuando-se a triagem familiar diante da suspeita clínica